Johnny Lee Cosby, OD
Individual provider Active NPI Optometrist · Meridian, MS
NPI 1528038296 · NPPES record last updated Jun 8, 2023
Key facts
- NPI
- 1528038296
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- S992TA577 (AL)
- Practice address
- 4721 26TH Ave
Meridian, MS 39305-4703 - Phone
- (601) 485-2020
- NPI assigned
- Jan 25, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 8
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- University Alabama Birmingham - School of Optometry, 2001
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Mississippi Band of Choctaw Indians
Practice addresses (Care Compare)
210 Hospital Cir
Choctaw, MS 39350-6781
Phone (601) 389-4500
210 Hospital Circle
Choctaw, MS 39350-6781
Hospital & facility affiliations
- Choctaw Health Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MS, TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230204000363 | MS | Practitioner - Optometry | 6709258544 | Reassigns benefits to 1 organization |
| I20250708004569 | TX | Practitioner - Optometry | 6709258544 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S992TA577 | AL | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mississippi Band of Choctaw Indians | Current |
Accepting new patients | |
| Primary Eyecare & Optical of Meridian, P.a. | Optometrist | Current |
Accepting new patients |
| Mississippi Band of Choctaw Indians | Current | Accepting new patients | |
| Mississippi Band of Choctaw Indians | Current | Accepting new patients | |
| Mississippi Band of Choctaw Indians | Current | Accepting new patients | |
| Primary Eyecare South LLC | Optometrist | Current |
Accepting new patients |
| Mississippi Band of Choctaw Indians | Current | Accepting new patients |
Locations
1930 N Pearl St
Carthage, MS 39051
Phone (601) 287-6639
210 Hospital Cir
Choctaw, MS 39350
Phone (601) 389-4500
376 Campus Rd
Conehatta, MS 39057
Phone (601) 389-4500
4721 26th Ave
Meridian, MS 39305
Phone (601) 485-2020
124 Big Creek Cir
Philadelphia, MS 39350
Phone (601) 389-4500
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | S992TA577 | AL | Yes |
Addresses
Primary practice location
4721 26TH Ave
Meridian, MS 39305-4703
Mailing address
3701 Espey Hedgepeth Rd
Bailey, MS 39320-9705
Phone (601) 934-2231
Other practice location 1
1 Boone Rd
Bremerton, WA 98312-1894
Phone (360) 475-4144
Other practice location 2
1801 Fuller Rd Ste A01
Meridian, MS 39309
Phone (601) 679-2213
Other providers in Meridian, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 8, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.